Oncology Revenue Integrity Specialist

Job Description

Company Description Southwest General Health Center is a 368-bed, non-profit hospital serving communities in southwestern Cuyahoga, northern Medina, and eastern Lorain counties. Founded in 1920 by local residents, it maintains a strong tradition of community partnership and commitment to patient-centered care. The hospital offers a full range of medical, surgical, and emergency services, supported by nationally recognized physicians and state-of-the-art technology, including a Level III trauma center. Patients and families benefit from robust social services and support groups that address mental, emotional, and spiritual needs. Guided by the mission “Health is our Passion. Quality is our Focus. Compassion is our Way,” Southwest General emphasizes excellence and individualized attention in every service.\n
Role Description The Oncology Revenue Integrity Specialist is a full-time, on-site role based in Cleveland, OH, focused on ensuring accurate and compliant oncology and hematology billing and revenue capture. This role involves reviewing clinical documentation, coding, and charge processes to identify discrepancies, optimize reimbursement, and maintain adherence to payer rules and regulatory requirements. The Specialist collaborates with oncology providers, clinical staff, billing teams, and Medical Affairs to clarify documentation, support accurate coding, and resolve denials or underpayments. Daily responsibilities include conducting audits, analyzing revenue trends, supporting process improvements, and preparing reports and recommendations to enhance revenue integrity. The role also contributes to staff education on oncology-specific coding, billing practices, and compliance standards.\n
Qualifications
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• Candidates should possess strong knowledge in Oncology and Hematology to accurately interpret clinical documentation and treatment plans.
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• Candidates should possess expertise in Medicine and Medical Affairs to collaborate effectively with clinicians and ensure alignment with clinical and administrative standards.
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• Candidates should possess solid Research skills to analyze data, identify revenue integrity issues, and support continuous process improvement.
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• Candidates should have proven experience with healthcare revenue cycle, coding (CPT, HCPCS, ICD), and billing practices, preferably in an oncology setting.
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• Candidates should demonstrate proficiency in regulatory compliance, payer guidelines, and documentation standards related to oncology services.
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• Candidates should have strong analytical, problem-solving, and detail-oriented skills, with the ability to interpret complex clinical and financial information.
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• Candidates should exhibit effective communication and collaboration skills to work with interdisciplinary teams and provide clear education and feedback.
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• Relevant certifications such as CPC, CCS, or CHONC and a background in health administration, nursing, or related fields are highly beneficial.
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